February is official Heart Month, not just your “emotional” heart commemorated by Valentines Day, but also your physical heart. I’ve talked to you a lot about the importance of exercise, good nutrition, reduction of stress in lessening your risk for heart attack, but there’s another condition I’d like to talk to you about that doesn’t get much attention until it happens. It’s a dangerous, life-threatening condition and most Americans don’t even know they have it.
AAA: Over 1 Million Americans Are Living with a Potential Killer
For about the last 10 years, the U.S. Preventive Task Force and the American Heart Association have recommended a screening for AAA’s – abdominal aortic aneurysms. An abdominal aortic aneurysm is a dilatation – or expansion – of the aorta, the largest blood vessel of your heart that feeds all the veins and arteries of your entire body.
Normally, your aorta is about 2 cm in diameter. If your aorta exceeds 3 cm, you’d be diagnosed as having an AAA. For some reason, AAA occurs 4 times more in men than women, yet the prevalence of occurrence in women has been rising since 2005 – no one quite knows why yet.
When AAA’s rupture, it’s much like a tire with a soft spot blowing out or an overblown balloon popping. The results can be catastrophic with complete bleed out occurring within minutes unless surgical intervention happens immediately. Needless to say, ruptured AAA’s create highly stressful Emergency Medical Services, as well as an Emergency Room surgery team challenge.
That’s why it’s so important to get screened for this potential killer condition. The American Heart Association feels that men ages 65-75, especially those who have ever smoked, are at much higher risk for AAA and rupture. Smoking makes your vascular structures more “friable” – that is, less elastic, weaker, with a kind of “cheesecloth” consistency instead of smooth, strong, pliable structures. This tissue damage comes directly from the inflammation caused by the numerous toxins in smoke.
Damaged vascular structures are at higher risk of developing aneurysmic outpouchings. Most aneurysms are smaller and can be managed on a watchful waiting basis. If these rupture, they are often survivable if medical attention is obtained quickly. But, some AAA’s can be quite large and when they rupture they almost always result in death.
Yet, most people who’ve had an aneurysm rupture never knew they had one. They go unnoticed because they generally don’t give any symptoms that would bring you to a doctor – that is until they rupture and make their presence known. It’s this unknown factor about AAA’s that makes screening for them all that more critical.
Currently, over 10,000 Americans die each year from ruptured AAA’s that were unknown to them. When a larger aneurysm ruptures, fatal blood loss can occur within minutes, yet a little less than 50% of people who suffer ruptures survive them. All the more reason you should get screened for one – knowing you have one leads to treatment that can save your life.
Recently, doctors at Kaiser Permanente health center recommended including a screening warning built into EHR’s – electronic health records – to alert doctors that they should screen certain patients for AAA’s. This recommendation came out of a study that showed when Kaiser Permanente’s integrated system implemented AAA screening into their system’s EHR’s technology, the number of unscreened, at-risk men was reduced by 50% over 15 months.
This is a pretty good reduction – but it’s not perfect. The drawback to putting these screening warnings into EHR’s depends on how integrated your doctor’s particular medical system is. For that reason, I feel it’s better for you to become proactive and simply ask your doctor for screening yourself especially if you are a man in the high risk age group.
Here are the current screening recommendations for AAA by the U.S. Task Force:
1. Men ages 65-75 should undergo 1 time screening to determine if they have a AAA especially if you have ever smoked in your lifetime.
2. For men ages 65-75 who have never smoked, the USTF doesn’t give any real recommendations, but I feel it wouldn’t hurt you, and could save your life, if you have the screen anyway.
3. The USTF recommends against routine screening in women, yet, make no mistake, women DO get AAA’s and die from them the same as men. If you’re a woman with a family member with aneurysms of any type, if you’ve ever smoked, I also think it’s a good idea for you to get screened as well.
How Is AAA Detected?
Screening for abdominal aortic aneurysm is simple and painless. It takes about 20 minutes to complete and is done as an outpatient procedure in your doctor’s office. It’s done via an abdominal ultrasound where gel is applied to your abdomen and a sonographic instrument is run over your abdomen. The technician views images of your aorta on the screen, measures your aorta, and looks at blood flow to determine an aneurysm. If one is found, your doctor will discuss with you the best possible method of treating it. I feel screening can offer you the best peace of mind and even save your life.
Ron Blankstein, M.D.